Abstract
Knowledge about fasciae has become increasingly relevant in connection to regional anesthesiology, given the growing interest in fascial plane, interfascial, and nerve blocks. Ultrasound (US) imaging, thanks to high definition, provides the possibility to visualize and measure their thickness. The purpose of this study was to measure and compare, by US imaging, the thickness of deep/muscular fasciae in different points of the arm and forearm. An observational study has been performed using US imaging to measure brachial and antebrachial fasciae thickness at anterior and posterior regions, respectively, of the arm and forearm at different levels with a new protocol in a sample of 25 healthy volunteers. Results of fascial thickness revealed statistically significant differences (p < 0.0001) in the brachial fascia between the anterior and the posterior regions; in terms of the antebrachial fascia, no statistically significant difference was present (p > 0.05) between the regions/levels. Moreover, regarding the posterior region/levels, the brachial fascia had a greater thickness (mean 0.81 ± 0.20 mm) than the antebrachial fascia (mean 0.71 ± 0.20 mm); regarding the anterior region/levels, the antebrachial fascia was thicker (mean 0.70 ± 0.2 mm) than the brachial fascia (mean 0.61 ± 0.11 mm). In addition, the intra-rater reliability reported good reliability (ICC2,k: 0.88). US imaging helps to improve grading of fascial dysfunction or disease by revealing subclinical lesions, clinically invisible fascial changes, and one of the US parameters to reliably evaluate is the thickness in the different regions and levels.
Highlights
Knowledge about the fasciae has become increasingly relevant in connection to regional anaesthesiology, given the growing interest in fascial plane, interfascial, and nerve blocks
With US, it is possible to demonstrate the thickening of a fascial layer, the changing of its echogenicity, and to analyze the relationships between fasciae, nerves, and vessels
It is mandatory, beforehand, to speak about fascial alteration in pathological conditions, to have a clear idea about the normal aspect of each fascia of the body, and to codify the best probe position to visualize them. While this knowledge is present for the thoracolumbar fascia and the fasciae of the inferior limbs, to date, no study has evaluated the fascial thicknesses of the brachial and antebrachial fasciae measured by ultrasound imaging in the different points
Summary
Knowledge about the fasciae has become increasingly relevant in connection to regional anaesthesiology, given the growing interest in fascial plane, interfascial, and nerve blocks. In recent years numerous investigations have been carried out on this topic to understand the anatomical features of the various fasciae of the body [2,4], both in cadavers and in live individuals using Ultrasound (US) Imaging [5,6,7,8] The latter, thanks to its high definition, the possibility to visualize the musculo–skeletal structures in a dynamic way and the lower cost when compared to other non-invasive methods [8,9,10], it has become an important tool for studying fascial anatomy and pathology in a rehabilitative point of view [5]. A review by Fede et al [13] reported that the ultrasound data collected for the same fascia differed depending on the ultrasonographer, probe position, and/or intra-individual anatomic variability It is mandatory, beforehand, to speak about fascial alteration in pathological conditions, to have a clear idea about the normal aspect of each fascia of the body, and to codify the best probe position to visualize them. While this knowledge is present for the thoracolumbar fascia and the fasciae of the inferior limbs, to date, no study has evaluated the fascial thicknesses of the brachial and antebrachial fasciae measured by ultrasound imaging in the different points
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